Stepping It Up For Women's HIV Prevention

By Shayna Buhler, Senior Program Officer, Interagency Coalition on AIDS and Development (ICAD)

When it comes to HIV, there's a long way to go to Step it up For Gender Parity by 2030, but progress is being made on several fronts. Key to addressing HIV among women and the gender inequities that fuel the epidemic among them, is the search for new prevention options that make sense in women's lives and give them the power to make decisions about their own sexual and reproductive health, including HIV prevention. Women continue to be at disproportionately high risk of HIV infection and AIDS is the leading cause of death worldwide for women of reproductive age.

Many women around the world are placed in situations where they are often unable to negotiate with their partners to be faithful or to use condoms. Stepping it up for gender parity requires that women have access to a range of HIV prevention options, including those that they can use without partner involvement if they choose. Recent advances in oral pre-exposure prophylaxis have contributed to an expanding set of options, and two weeks ago, the results of two vaginal microbicide trials were released, taking us one momentous step forward along this path.

Microbicides are biomedical products being developed to protect healthy people from becoming infected with HIV during sex. Both the Ring Study, led by the International Partnership for Microbicides (IPM), and ASPIRE, led by the US national Institutes of Health -funded Microbicide Trials Network (MTN) demonstrated that a monthly vaginal ring containing the anti-retroviral drug dapivarine worked to safely reduce the risk of HIV infection among the women who wore them. This was the first time that two studies have confirmed that a vaginal microbicide can safely offer protection against HIV. Participants from this and other trials, their communities, prevention advocates and researchers have been working and waiting for this moment for a long time.

The results of the two trials were positive but not overwhelmingly so. The trial showed that compared to the placebo, the monthly dapivarine ring reduced the risk of HIV infection by 31 percent and 27 percent respectively. Much more will be learned as the data continues to be analyzed but a couple of things seem clear. One, the ring works much better when it is used consistently. It works best when it is kept in for the full 30 days and then replaced with a new ring. This is not surprising. We have learned of the importance of consistent use with oral pre-exposure prophylaxis and from previous microbicide trials.

We know this to be true for condoms as well-- if they aren't used consistently and correctly, they just don't work as well. We also know that the women in the trial removed a ring that to their knowledge may have contained either dapivarine or a placebo, and that dapivarine may or may not work to prevent HIV infection. They were being reminded of these uncertainties at every clinic visit. In Open Label Extension studies that will follow, in which participants from both placebo and dapivarine arms of the trial can participate and access the monthly dapivarine ring (without being blinded), we will be able to get a much clearer picture of how consistently women might use a product that they know contains a drug that has been proven to work.

The studies also indicate that the dapivarine ring showed higher efficacy among women over the age of 21 and showed little to no protection in women ages 18 to 21. More research and analysis will help us to understand whether this is due to different levels of consistency in usage, or due to some other factor such as biological difference.

Young women desperately need more prevention options--globally, they face excessively high rates of HV infection, and may have less power than older women to negotiate the terms of their sexual relationships. But women aged 22 to 26 also have extremely high rates of HIV infection and we cannot underestimate the value of expanding prevention options for this age group.

We have only to look at the example of birth control to be reminded that as women's lives change, so too will their decisions around sexual and reproductive health. A woman can go through several different birth control options throughout the reproductive life cycle, depending on what she has access to, her lifestyle, the level of risk she is willing to take on, her changing preferences and her biology.

There is no product that will be right for all women, and this highlights the necessity of developing a range of accessible options and to working with young women to figure out what they can and will use as HIV prevention, and of ensuring that young women have access to all prevention options, even if they won't all choose to use them.

In September 2015, world leaders adopted the 2030 Agenda for Sustainable Development, which includes a set of 17 goals interlinked to end poverty, fight inequality and injustice, and tackle climate change by 2030. Preventing new HIV infections among women through an expanded range of prevention options has the potential to have an incredible impact on the Sustainable Development Goals, from addressing food security, advancing gender equity, building healthier communities -- all contributing to economic growth.

Increasing the number of women who are living without HIV, and who have control over their sexual and reproductive health and rights, can face fewer challenges in going to school or work, caring for their children, giving birth to HIV negative children, and facing fewer strains on resources, which is a critical step towards gender equality.

Developing and providing women with access to and knowledge about tools to make decisions about their sexual and reproductive health, possibly with and possibly without negotiation with their partners, is an incredible step towards gender equality. This International Women's Day, the recent trial results are cause for celebration and call for the redoubling of advocacy efforts to ensure that safe and effective products make it to the hands of the women who need them and that research and development continue to increase the number of options available to all women to prevent HIV infection.

Shayna Buhler is a Senior Program Officer with the Interagency Coalition on AIDS and Development (ICAD). ICAD provides leadership in the response of Canadian international development organizations and Canadian HIV organizations in reducing the impact of the global HIV and AIDS epidemic.

This blog is part of an International Women's Day series produced by the Interagency Coalition on AIDS and Development (ICAD) in recognition of International Women's Day 2016 (March 8). The series runs during the week of March 7, 2016 and will feature a selection of blogs written by our member and partner organizations who will share their broad range. Each provides their perspective and their insight on what must be done to achieve UN Women's campaign of "Planet 50-50 by 2030: Step It Up for Gender Equality" as we embark on the race to meet our 2030 Goals for Sustainable Development.

Disclaimer: The views and opinions expressed in this blog series are those of the authors and do not necessarily reflect those of ICAD.